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  • 1
    Language: English
    In: Singapore medical journal, November 2015, Vol.56(11), pp.622-5
    Description: The prevalence of perceived food allergies exceeds that of true food allergies. Unnecessary food avoidance may increase parental and patient anxiety, reduce quality of life and increase the risk of nutritional deficiency. An oral food challenge (OFC) can provide an objective measure regarding the presence or absence of food allergies in a child. This study reviews the indications for and outcomes of OFCs performed on children. A retrospective review was performed on all children who underwent OFCs at the Allergy Unit of the National University Hospital, Singapore, over a three-year period. A total of 197 OFCs were performed among 58 patients (34 male, 24 female). Most of the tests were for allergies to tree nuts (n = 107). Among the OFCs, 43.1% were for foods that were avoided and never eaten due to perceived food allergies, 25.9% were for foods that had previously resulted in positive skin prick tests (SPTs) and/or immunoassay results, 16.2% were for foods thought to worsen eczema and 14.7% were for foods thought to have caused a previous reaction. Of all the OFCs, 5% were positive, although adverse reactions were mostly cutaneous. Challenge-positive patients had either positive SPTs (wheal 〉 3 mm) or raised serum immunoglobulin E levels to specific foods that they reacted to during the challenges. No episodes of anaphylaxis were reported after the challenge. Most of the patients were able to safely introduce the avoided foods into their diets. OFCs provide an objective assessment for suspected food allergies.
    Keywords: Food Allergy ; Indications ; Oral Food Challenges ; Outcomes ; Safety ; Quality of Life ; Tertiary Care Centers ; Food -- Adverse Effects ; Food Hypersensitivity -- Epidemiology
    ISSN: 0037-5675
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  • 2
    Language: English
    In: The Journal of Allergy and Clinical Immunology, June 2017, Vol.139(6), pp.2000-2003
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jaci.2016.10.038 Byline: Tosha Ashish Kalhan (a), Evelyn Xiu Ling Loo (b), Ashish Chetan Kalhan (a), Michael S. Kramer (c)(d)(e), Bindu Karunakaran (a), Carolina Un Lam (a), Hugo Van Bever (f)(g), Lynette Pei-chi Shek (b)(f)(g), Anne Goh (h), Yap Seng Chong (i), Bee Wah Lee (g)(j), Peter Gluckman (k)(l), Kenneth Kwek (m), Seang Mei Saw (n), Keith Godfrey (o)(p), Chin-Ying Hsu (a) Author Affiliation: (a) Discipline of Oral Sciences, Faculty of Dentistry, National University of Singapore, Singapore (b) Singapore Institute of Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore (c) Department of Pediatrics, McGill University, Faculty of Medicine, Montreal, Quebec, Canada (d) Department of Epidemiology and Biostatistics, McGill University, Faculty of Medicine, Montreal, Quebec, Canada (e) Department of Epidemiology, Biostatistics & Occupational Health, The Montreal Children's Hospital, Montreal, Quebec, Canada (f) Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore (g) Department of Paediatrics, National University of Singapore, Singapore (h) Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore (i) Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (j) Mount Elizabeth Medical Centre, Singapore (k) Growth, Development and Metabolism Programme, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore (l) Liggins Institute, University of Auckland, Auckland, New Zealand (m) Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore (n) Saw Swee Hock School of Public Health, National University of Singapore, Singapore (o) NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom (p) Medical Research Council Lifecourse Epidemiology Unit, Southampton, United Kingdom Article Note: (footnote) This research is supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC), Singapore (grant no. NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. This study was also funded by Singapore's NMRC (grant nos. NMRC/CIRG/1341/2012: R-221-000-059- 511 and NMRC/CSA/022/2010) and NRF370062-HUJ-NUS., Disclosure of potential conflict of interest: L. P.-chi Shek has consultant arrangements with Mead Johnson and Nestle; has received payment for lectures from Danone and Nestle; and has received research funding from Danone. Y. S. Chong and P. Gluckman have received research collaborations and funding from Abbott, Danone, and Nestec. B. W. Lee has received honoraria for serving on an advisory board for Nestle Nutrition, has received payment for lectures from Danone Nutrition, and has received travel support from the Asia Pacific Association of Allergy Asthma and Immunology. K. Godfrey has received payment for lectures from Nestle Nutrition Institute; has received grants from Abbott Nutrition and Nestec; has patents issued for phenotype prediction and predictive use of CpG methylation; and has a patent pending for maternal nutrition composition. The rest of the authors declare that they have no relevant conflicts of interest.
    Keywords: Medicine
    ISSN: 0091-6749
    E-ISSN: 1097-6825
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  • 3
    Language: English
    In: Asian Pacific journal of allergy and immunology, December 2013, Vol.31(4), pp.330-3
    Description: NSAID intolerance is not uncommon. Etoricoxib, a cox-2 inhibitor NSAID, has been shown to be a safe alternative in these patients. This study aims to determine the rate of NSAID intolerant patients who are able to tolerate etoricoxib without adverse reactions. This study analyzed charts and electronic databases of all patients referred to the allergy clinics of the National University Hospital and Gleneagles Hospital in Singapore from 2006-2011 for oral provocation tests to etoricoxib (cumulative dose of 120 mg), on the background of NSAID intolerance. Demographics, atopic comorbidities, history of chronic urticaria, inciting NSAID, onset and type of reaction, and provocation test outcomes were obtained. A total of 74 patients (mean age 37; range: 16-72 years) underwent provocation tests to etoricoxib. Of these, 59% were female. Majority were Chinese (69%), followed by Malay (12%), Caucasian (8%), Indian (5%) and various other races (6%). Forty-six percent of the study population had atopic comorbidities, and 4% had concomitant chronic urticaria. Eighty percent of patients had a history of intolerance to 1 NSAID, while the rest (20%) had intolerance to multiple NSAIDS. Forty-one percent of patients had concomitant acetaminophen intolerance. Some of the patients had multiple symptoms on presentation, the most common of which were periorbital and facial edema (90%), breathing difficulties (26%) and urticaria (25%), with the onset of reaction occurring mostly within 30 minutes to 1 hour. Etoricoxib was tolerated in 95% of the patients. Subjects who reacted to the challenge all had mild reactions which resolved with antihistamines. Etoricoxib is a safe alternative in NSAID intolerant patients. Nevertheless, it is advised that patients should undergo provocation tests to confirm tolerance.
    Keywords: Analgesics -- Adverse Effects ; Anti-Inflammatory Agents -- Adverse Effects ; Drug Hypersensitivity -- Epidemiology ; Pyridines -- Adverse Effects ; Sulfones -- Adverse Effects
    ISSN: 0125-877X
    E-ISSN: 22288694
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  • 4
    Language: English
    In: BMC Research Notes, March 20, 2014, Vol.7(1)
    Description: Background Studies have suggested that selective microbial targets prevail in the fecal microbiota of infants with eczema. This study evaluated the composition of fecal microbiota of infants who developed eczema in the first 5 years of life and compared these with those of healthy controls. Findings Children who developed eczema in the first 2 years, those with eczema at 5 years of age and healthy controls were selected from the placebo arm of a birth cohort of at-risk infants participating in a randomized double-blind trial on the protective effects of supplemental probiotics in early life on allergic outcomes. Molecular evaluation of fecal microbiota were conducted using Fluorescence In Situ Hybridization-Flow Cytometry (FISH-FC) for fecal samples collected. Longitudinal analysis of fecal microbiota composition at three days, one and three months and one year of life revealed higher abundance of Enterobacteriaceae [coefficient (B): 1.081, 95% CI: 0.229-1.933, adj p = 0.014] and Clostridium perfringens [coefficient (B): 0.521, 95% CI: 0.556-0.988, adj p = 0.03] in those who developed eczema in the first 2 years life. In those with eczema at 5 years of age, a lower abundance of Bifidobacterium was observed [coefficient (B): -27.635, 95% CI: -50.040 - -5.231, adj p = 0.018]. Conclusions The differences in infant fecal microbiota observed in eczema subjects in this study support the notion that relative abundance of selective microbial targets may contribute to the subsequent development of eczema in childhood.
    Keywords: Microbiota (Symbiotic Organisms) -- Comparative Analysis
    ISSN: 1756-0500
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  • 5
    Language: English
    In: Journal of immunology (Baltimore, Md. : 1950), 01 July 2011, Vol.187(1), pp.462-71
    Description: CD4(+) memory/effector T cells play a central role in orchestrating the rapid and robust immune responses upon re-encounter with specific Ags. However, the immunologic mechanism(s) underlying these responses are still not fully understood. To investigate this, we generated an allergen (major house dust mite allergen, Blo t 5)-specific murine Th2 cell line that secreted IL-4, IL-5, IL-10, and IL-13, but not IL-9 or TNF-α, upon activation by the cognate Ag. These cells also exhibited CD44(high)CD62L(-) and CD127(+) (IL-7Rα(+)) phenotypes, which are characteristics of memory/effector T cells. Experiments involving adoptive transfer of this Th2 cell line in mice, followed by three intranasal challenges with Blo t 5, induced a dexamethasone-sensitive eosinophilic airway inflammation. This was accompanied by elevation of Th2 cytokines and CC- and CXC-motif chemokines, as well as recruitment of lymphocytes and polymorphic mononuclear cells into the lungs. Moreover, Blo t 5-specific IgE was detected 4 d after the last intranasal challenge, whereas elevation of Blo t 5-specific IgG1 was found at week two. Finally, pulmonary delivery of the pVAX-IL-35 DNA construct effectively downregulated Blo t 5-specific allergic airway inflammation, and i.m. injection of pVAX-IL-35 led to long-lasting suppression of circulating Blo t 5-specific and total IgE. This model provides a robust research tool to elucidate the immunopathogenic role of memory/effector Th2 cells in allergic airway inflammation. Our results suggested that IL-35 could be a potential therapeutic target for allergic asthma through its attenuating effects on allergen-specific CD4(+) memory/effector Th2 cell-mediated airway inflammation.
    Keywords: Immunologic Memory ; Antigens, Plant -- Immunology ; Immunoglobulin E -- Biosynthesis ; Inflammation Mediators -- Physiology ; Interleukin-12 Subunit P35 -- Physiology ; Lung -- Immunology ; Mites -- Immunology ; Th2 Cells -- Immunology
    ISSN: 00221767
    E-ISSN: 1550-6606
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 6
    Language: English
    In: World Allergy Organization Journal, Dec 2, 2015, Vol.8(1)
    Description: Introduction From a birth cohort of at-risk Asian infants, we prospectively investigated the role of early onset allergen sensitization and clinical phenotypes as risk factors for atopic disorders at the age of 5 years. Methods and materials The study recruited 253 families with a history of allergic disease in a first degree relative from an antenatal clinic in Singapore. The children were followed prospectively to assess clinical outcomes and skin prick test was performed at 2 and 5 years of age. Results Allergen sensitization (food and/or house dust mites) alone at 2 years of age was not associated with increased risk of wheeze and eczema at 5 years. However, the clinical phenotype (eczema and wheeze) with or without the presence of concomitant allergen sensitization at 2 years increased this risk. For eczema, eczema alone at year 2 increased the risk of eczema at year 5 (adjOR = 7.1; 95 % CI: 1.8-27.8) and this was further increased by the presence of allergen sensitization (adjOR = 25.4; 95 % CI: 4.7-138.5) and the concomitant presence of both wheeze and allergen sensitization (adjOR = 64.9; 95 % CI: 4.7-900.0). For wheeze, wheeze alone at 2 years (adjOR = 4.5; 95 % CI: 1.4 -14.8), and wheeze with concomitant allergen sensitization and eczema (adjOR = 13.9; 95 % CI: 1.2-168.5) increased the risk of wheeze at 5 years. The exception was rhinitis, where allergen sensitization alone at 2 years (adjOR = 5.6; 95 % CI: 1.1-29.2) increased the risk of rhinitis at 5 years. Early onset of eczema at 2 years also increased the risk of rhinitis (adjOR = 6.8; 95 % CI: 2.0-23.1). Conclusion In this Asian birth cohort, the clinical phenotype (eczema and wheeze) with or without concomitant allergen sensitization in the first 2 years of life were strong predictors of atopic disorders at 5 years. Keywords: Eczema, Wheeze, Rhinitis, Allergen sensitization
    Keywords: Allergy – Genetic Aspects ; Allergy – Risk Factors
    ISSN: 1939-4551
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  • 7
  • 8
    Language: English
    In: World Allergy Organization Journal, 01 December 2018, Vol.11(1), pp.1-11
    Description: Abstract Background The prevalence of allergic diseases, such as asthma, allergic rhinitis, eczema and food allergy, has been increasing worldwide, as shown in a large number of studies, including the International Study of Asthma and Allergies in Childhood (ISAAC). However, there is significant...
    Keywords: Medicine
    E-ISSN: 1939-4551
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  • 9
    Language: English
    In: Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology, 2016, Vol.12, pp.56
    Description: Immune responses in allergic diseases begin with allergen sensitization, which usually occurs in childhood. Allergen sensitization involves a complex interplay of genetic and environmental factors, and sensitization patterns may change with age. To determine the predictors of allergen sensitization in the first 3 years of life in the growing up in Singapore towards healthy outcomes (GUSTO) prospective birth cohort study. Interviewers collected information on demographics, family history of allergy, social and lifestyle factors, and the child's health. We analyzed data from 849 children who completed skin prick testing (SPT) to inhalant allergens (house dust mites: , and ) and food allergens (egg, peanut and cow's milk) to assess risk factors for allergen sensitization at 18 months. To ensure that clinical phenotypes preceded allergen sensitization, we also analyzed data from 649 children who had a negative skin prick test at 18 months and completed skin prick testing at 36 months. We observed a significant association between eczema reported before 18 months and a positive SPT at 18 months [aOR 4.5 (1.9-10.7)]. Ninety-five (14.6 %) children with negative SPTs at 18 months developed positive tests at 36 months. Onset of eczema before 18 months was associated with an increased risk of new allergen sensitization at 36 months among children non-sensitized at 18 months [aOR 3.4 (1.2-9.3)]. An association was seen between wheeze reported before 18 months and new allergen sensitization at 36 months [aOR 3.2 (1.1-9.1)]. We found no significant association, however, between rhinitis reported before 18 months and new allergen sensitization at 36 months. Early onset of eczema and wheeze are risk factors for later allergen sensitization, suggesting a possible increased susceptibility to allergen exposure through an impaired skin barrier or defective airway epithelium. NCT01174875 Registered 1 July 2010, retrospectively registered.
    Keywords: Allergen Sensitization ; Eczema ; Predictors ; Skin Barrier ; Wheeze
    ISSN: 1710-1484
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 10
    In: Internal Medicine Journal, September 2016, Vol.46, pp.11-12
    Description: Byline: Elizabeth Huiwen Tham, Toh Jia Ying, Evelyn Xiu Ling Loo, Anne Goh, Oon Hoe Teoh, Yap Seng Chong, Seang Mei Saw, Kenneth Kwek, Peter D Gluckman, Keith M Godfrey, Hugo Van Bever, Lynette Pei-chi Shek, Chong Mary F, Bee Wah Lee ***** No abstract is available for this article. *****
    Keywords: Food Hypersensitivity;
    ISSN: 1444-0903
    E-ISSN: 1445-5994
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